title: Use of natural orifice translumenal endoscopic surgery in the diagnosis of suspected tuberculous peritonitis: a retrospective case series of 7 patients.
abstract: OBJECTIVE
  In cases of ascites of unknown etiology, tuberculosis peritonitis (TBP) is a possible cause but a diagnostic challenge. This retrospective case series assessed the effectiveness and safety of diagnostic natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) in 7 consecutive patients with suspected TBP.
  
  
  METHODS
  Between September 2011 and August 2012, peritoneal biopsy was performed using transgastric NOTES for subsequent histology in 7 consecutive hospitalized patients who presented with ascites and were diagnosed with suspected TBP. The outcome measures included diagnostic accuracy and procedure-related morbidities.
  
  
  RESULTS
  Diagnostic NOTES was successfully completed in all 7 patients. Peritoneoscopy with NOTES went uneventfully and lasted 5-10 minutes. Typical peritoneal nodules characteristic of TBP were identified in all patients and confirmed pathologically as TBP. No clinically significant adverse events occurred in any patients following NOTES, except for 1 patient who experienced mild and transient pyrexia. Postoperative blood culture detected no microbial growth. Follow-up upper gastrointestinal endoscopy showed that the gastric wall wound healed well with minimal scarring. All patients were prescribed a standard four-drug antituberculosis chemotherapy regimen. The treatment outcomes were determined to be effective or curative, and no relapse was detected within the follow-up period.
  
  
  CONCLUSIONS
  NOTES is an effective and safe diagnostic technique in patients with suspected TBP presenting as ascites of unknown etiology.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: You-Xiang
authors.initials: YX
authors.lastname: Chen
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Zeng
authors.forename: Xu
authors.initials: X
authors.lastname: Shu
authors.forename: Xiao-Jiang
authors.initials: XJ
authors.lastname: Zhou
authors.forename: Jiu-Hong
authors.initials: JH
authors.lastname: Ma
authors.forename: Nong-Hua
authors.initials: NH
authors.lastname: Lv
mesh_terms: D000293:Adolescent; D000328:Adult; D001201:Ascites / Q000175:diagnosis / Q000601:surgery; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome